President Writes - March 2017
"These are immensely difficult decisions and are a clear reflection of the tough times our health service is facing"
This year sees the College’s close involvement with two significant UK-wide initiatives – citizenAID and the Smoking and Surgery campaign – both of which have far-reaching implications. CitizenAID was developed by civil and military clinicians who are experienced in treating blast and gunshot injuries. The campaign faces up to the need to equip the general public with elementary skills to stem haemorrhage and give life-saving first aid in the aftermath of a multiple-casualty event before the arrival of emergency services.
Launched in January 2017, the citizenAID app had more than 4,000 downloads within two weeks in the UK and a further 1,000 in the US. Hot on the heels of citizenAID is our Smoking and Surgery campaign, undertaken in partnership with the charity Action on Smoking and Health (ASH). The campaign aims to encourage patients to improve their outcomes (and, in some cases, survival prospects) by stopping smoking ahead of surgery, and it has received widespread support from a number of other medical colleges. The campaign cites reduced complication rates, shortened hospital stays and better long-term outcomes in non-smokers. We are also concerned about the impact of smoking on dental practice and have noted increased failure rates following implant surgery for those who continue to smoke.
Most of you will have received your subscription mailings for 2017 which, for the first time, include an infographic (pictured below) that outlines our achievements in 2016 along with our 50 Reasons booklet, which showcases what the College has to offer. These two enclosures are the first output of our new marketing strategy, led by Council Member Mike Griffin and Director of Communications and Membership Sarah Allen and her team. I hope the information provided will be a useful stimulus for discussion to encourage your colleagues to join our College. The infographic and 50 Reasons are just the start of a major marketing initiative that will leave our College well placed to face the challenges ahead.
NHS England winter pressures have dominated news headlines in these past weeks. It is by no means a new story, with a similar pattern of events and press coverage evident in recent years. What has been different this year has been the extent of the problem, with 65 of 152 trusts declaring operational pressure alerts in January. Most of the strain was felt in the south of England, with cripplingly high rates of bed occupation and the worst A&E four-hour waiting-time performance since collection of this metric began in 2004. There were similar issues in Wales, Northern Ireland and, to a lesser extent, Scotland. In the devolved healthcare systems, it is interesting to see that each of the four UK nations has produced its own response to the problems of NHS pressure – the Bengoa Report in Northern Ireland, a new Parliamentary Review of Health and Social Care in Wales, sustainability and transformation plans in England, and the National Clinical Strategy in Scotland.
What is clear from these reports, and must come as no surprise, are the underlying causes that are common to all: increasing demands from an ageing population with multiple co-morbidities, a desperate need to reconfigure services to protect elective practice and allow unrestricted access to non-scheduled care, and the overwhelming need to take the pressure off delivery of secondary care by reinvigorating primary care and providing adequate social care services.
Under these circumstances, it is all too easy to adopt a blame culture and seek a scapegoat as to why we are in this position. This approach will not succeed. Nor is it, in my view, particularly helpful to draw odious comparisons between various NHS models of delivery.
It is, though, an opportunity for all four corners of the NHS to work together and identify the most successful elements in the system. Prevention through better public-health awareness, the Choosing Wisely campaign and many other initiatives will help service delivery, but it will take time for their impact to be felt and, in the meantime, the existing pressures will not recede. Whatever plan emerges, the outcome will be bleak unless we can secure adequate funding for our health service. I do have some sympathy for those clinical commissioning groups who have looked to reset the bar that triggers access to certain elective procedures or treatments. These are immensely difficult decisions to make and are a clear reflection of the tough times our health service is facing.
We need to lobby through every route for the necessary finances to close the funding gap and sustain our health service. To reap any reward, we will need a significant investment. If that isn’t forthcoming, I fear we shall have to have the difficult conversation as to whether or not we can continue to provide an all-inclusive health service that is free to everyone at the point of delivery. I have heard the sustainability and transformation plans for NHS England described as the ‘last chance saloon’ for the NHS. Let us hope that is not the case.
However, I should like to finish on a more optimistic note. Our College has just signed a memorandum of understanding with Aston Medical School, working together to support students from disadvantaged backgrounds in the West Midlands to gain entry to medical school through a package of educational and financial support. This example of inclusivity resonates well with the key theme of my presidency.